Pregnancy outcomes in patients with systemic lupus erythematosus with or without a history of lupus nephritis

2021 ◽  
Author(s):  
Yuko Oishi ◽  
Hidekazu Ikeuchi ◽  
Hiroko Hamatani ◽  
Masao Nakasatomi ◽  
Toru Sakairi ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Lupus Nephritis ◽  
Lupus Erythematosus ◽  
Pregnancy Outcomes ◽  
Systemic Lupus ◽  
History Of

“Protenuria in SLE: Is it always lupus?”

Lupus ◽  
2021 ◽  
pp. 096120332098345
Author(s):  
Alessandra Ida Celia ◽  
Roberta Priori ◽  
Bruna Cerbelli ◽  
Francesca Diomedi-Camassei ◽  
Vincenzo Leuzzi ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Lupus Nephritis ◽  
Fabry Disease ◽  
Histological Examination ◽  
Lupus Erythematosus ◽  
Systemic Lupus ◽  
Kidney Involvement ◽  
History Of ◽  
Genetic Assay

Proteinuria is one of the most typical manifestations of kidney involvement in Systemic Lupus Erythematosus (SLE). We report the case of a 23-year-old woman with a 6-year-long history of SLE presenting with proteinuria after a three-year remission on hydroxychloroquine. Kidney histological examination showed alterations inconsistent with lupus nephritis and suggestive of hydroxychloroquine toxicity or Fabry disease. The latter was confirmed by genetic assay.

Pregnancy outcomes in systemic lupus erythematosus (SLE) women

2019 ◽  
Vol 40 (3) ◽  
Author(s):  
Aida Kalok ◽  
Rizna Abdul Cader ◽  
Ima Indirayani ◽  
Abdul Kadir Abdul Karim ◽  
Shamsul Azhar Shah ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Lupus Nephritis ◽  
Preterm Delivery ◽  
Antiphospholipid Syndrome ◽  
Lupus Erythematosus ◽  
Pregnancy Outcomes ◽  
Systemic Lupus ◽  
Foetal Loss ◽  
Active Disease ◽  
In Pregnancy

Abstract Background Systemic lupus erythematosus (SLE) is a chronic autoimmune inflammatory condition with multi-organ involvement predominantly affecting young women. There are very limited studies in pregnancy in Asian SLE patients and therefore we embarked on this study to identify pregnancy outcomes of Malaysian women with SLE. Materials and methods We performed a retrospective study of pregnancy outcomes in SLE patients in our institution from January 2007 to December 2014. A total of 71 pregnancies from 44 women were analysed. Results The mean age of our cohort was 30.5 ± 3.9 years. The rate of active disease at conception, antiphospholipid syndrome and lupus nephritis were 22.5%, 32.4% and 57.7% respectively. SLE flare occurred in 33 out of 71 pregnancies whereas 19 pregnancies were complicated with preeclampsia. The livebirth rate for our cohort was 78.9%, whilst preterm delivery was 42.9%. On univariate analysis, active disease and flare in pregnancy were both strongly associated with foetal loss and preterm delivery. Lupus nephritis (p = 0.011), SLE flare (p = 0.008) and antiphospholipid syndrome (p = 0.032) significantly increased the risk of preeclampsia. Aspirin and hydroxychloroquine were protective against foetal loss [odds ratio (OR) 0.12] and preeclampsia (OR 0.25), respectively. On multivariate analysis, active disease was a predictor of SLE flare (p = 0.002) and foetal loss (p = 0.018) and SLE flare was the main predictor of preterm delivery (p = 0.006). Conclusions Pregnancies in women with SLE should be planned and aspirin and HCQ use were beneficial in reducing adverse pregnancy outcomes.

scholarly journals Trichophyton erinacei Onychomycosis: The First to Evidence a Proximal Subungual Onychomycosis Pattern

2019 ◽  
Vol 11 (2) ◽  
pp. 198-203 ◽  
Author(s):  
Sutasinee Phaitoonwattanakij ◽  
Charussri Leeyaphan ◽  
Sumanus Bunyaratavej ◽  
Kittipoom Chinhiran
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Decision Making ◽  
Lupus Nephritis ◽  
Lupus Erythematosus ◽  
Drug Susceptibility ◽  
Mycological Cure ◽  
Drug Susceptibility Test ◽  
Systemic Lupus ◽  
Trichophyton Erinacei ◽  
History Of

Trichophyton erinacei is an emerging cause of dermatophyte infections, which are frequently isolated from hedgehogs. Nail infections from T. erinacei are rarely reported. We describe the case of a 23-year-old Thai female who had a history of systemic lupus erythematosus with lupus nephritis type III and who developed widespread skin and nail infections caused by T. erinacei that were most likely transmitted from a hedgehog. Although the patient did not demonstrate a clinical improvement or mycological cure following systemic itraconazole and fluconazole treatment, she achieved clinical and mycological cures after terbinafine therapy. A drug susceptibility test should be performed in patients with T. erinacei infections to facilitate decision-making about antifungal therapy. Here, we are the first to report a case of proximal subungual onychomycosis from a T. erinacei infection.

Albumin-to-globulin ratio (AGR) as a potential marker of predicting lupus nephritis in Chinese patients with systemic lupus erythematosus

Lupus ◽  
2021 ◽  
pp. 096120332098113
Author(s):  
Xin-Ran Liu ◽  
Yuan-Yuan Qi ◽  
Ya-Fei Zhao ◽  
Yan Cui ◽  
Xiao-Yang Wang ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Lupus Nephritis ◽  
Renal Impairment ◽  
Lupus Erythematosus ◽  
Newly Diagnosed ◽  
Systemic Lupus ◽  
Increased Risk ◽  
History Of ◽  
Albumin To Globulin Ratio

Objectives To evaluate a potential role of albumin-to-globulin ratio (AGR) in the development of lupus nephritis (LN) and determine the potential to use AGR as a marker for future LN in systemic lupus erythematosus (SLE) patients. Methods 194 newly diagnosed SLE patients without renal impairment were followed. The clinical data were collected and analyzed at the time of initial diagnosis of SLE and the end of follow-up. We compared baseline characteristics between those who did or did not develop LN on follow-up. Univariate and multivariate Cox hazard analysis were used to identify predictors of lupus nephritis. Results Among the 194 newly diagnosed SLE patients without renal impairment, 26 (13.40%) patients were diagnosed with LN during a median follow-up of 53.87 months. On univariate Cox analysis, patients with the history of alopecia, higher SBP, lower AGR, lower CRP, lower C3, lower C4, higher anti-dsDNA Ab, presence of ANA homogeneous patterns or higher SLEDAI had an increased probability of developing LN. In a multivariate model, the history of alopecia (adjust hazard ratio, aHR = 3.614, 95%CI 1.365-9.571 P = 0.010), lower AGR (aHR = 6.968, 95%CI 1.873-25.919, P = 0.004), lower CRP (aHR = 4.230, 95%CI 1.591-11.247, P = 0.004) and higher level of anti-dsDNA (aHR = 2.675, 95%CI 1.008-7.093, P = 0.048) were independently associated with an increased risk of developing LN after adjusting for covariates. Conclusion Our findings indicated that SLE patients with low AGR, low CRP, high anti-dsDNA and the history of alopecia were more likely to develop LN in the course of SLE. AGR shown the greatest hazard for developing LN among them, it may be a strong predictor.

scholarly journals Adverse Pregnancy Outcomes after Multi-Professional Follow-Up of Women with Systemic Lupus Erythematosus: An Observational Study from a Single Centre in Sweden

2020 ◽  
Vol 9 (8) ◽  
pp. 2598
Author(s):  
Muna Saleh ◽  
Christopher Sjöwall ◽  
Helena Strevens ◽  
Andreas Jönsen ◽  
Anders A. Bengtsson ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Lupus Nephritis ◽  
Lupus Erythematosus ◽  
Pregnancy Outcomes ◽  
Laboratory Data ◽  
Adverse Pregnancy Outcomes ◽  
Clinical Feature ◽  
Systemic Lupus ◽  
Adverse Pregnancy

While the management of pregnant patients with systemic lupus erythematosus (SLE) has improved over the last decades, the risk of maternal, foetal, and neonatal complications is still substantial. We evaluated the occurrence of adverse pregnancy outcomes (APO) occurring in 2002–2018 among patients with SLE from the catchment area of the Department of Rheumatology in Lund, Sweden. Longitudinal clinical and laboratory data were collected and analysed. Results were stratified according to the sequence of conception. We investigated a total of 59 pregnancies in 28 patients. Prior lupus nephritis was the clinical feature that, in a multivariable regression analysis, displayed the strongest association with APO overall (OR 6.0, p = 0.02). SLE combined with antiphospholipid syndrome (APS) was associated with the risk of miscarriage (OR 3.3, p = 0.04). The positivity of multiple antiphospholipid antibodies (aPL) was associated with APO overall (OR 3.3, p = 0.05). IgG anti-cardiolipin during pregnancy resulted in a higher risk of preterm delivery (OR 6.8, p = 0.03). Hypocomplementaemia was associated with several APO, but only in the first pregnancies. We conclude that, despite the close follow-up provided, a majority of pregnancies resulted in ≥1 APO, but a few of them were severe. Our study confirms the importance of previous lupus nephritis as a main risk factor for APO in patients with SLE.

scholarly journals A Systematic Review and Meta-Analysis of Pregnancy Outcomes in Patients with Systemic Lupus Erythematosus and Lupus Nephritis

2010 ◽  
Vol 5 (11) ◽  
pp. 2060-2068 ◽  
Author(s):  
Andrew Smyth ◽  
Guilherme H.M. Oliveira ◽  
Brian D. Lahr ◽  
Kent R. Bailey ◽  
Suzanne M. Norby ◽  
...  
Keyword(s):  
Systematic Review ◽  
Systemic Lupus Erythematosus ◽  
Lupus Nephritis ◽  
Lupus Erythematosus ◽  
Pregnancy Outcomes ◽  
Meta Analysis ◽  
Systemic Lupus

scholarly journals EP16 Challenges in treating new onset systemic lupus erythematosus with lupus nephritis and COVID-19 infection overlap

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Selma Dahou ◽  
Tim Leach ◽  
Kathryn Bostock ◽  
Jonathan Louden ◽  
Jonathan Raj ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Case Report ◽  
Lupus Nephritis ◽  
Immunosuppressive Therapy ◽  
Lupus Erythematosus ◽  
Childbearing Age ◽  
Systemic Lupus ◽  
Suitable Alternative ◽  
Increased Risk ◽  
History Of

Abstract Case report - Introduction COVID-19 infection caused by a novel coronavirus SARS-coV-2 has made the diagnosis and the treatment of inflammatory diseases incredibly challenging. On the one hand, because of its pro-inflammatory state, that may aggravate or trigger flares in autoimmune diseases such as systemic lupus erythematosus (SLE). On the other hand, the risk of an immunosuppressive therapy during the active phase SARS-coV-2 infection that may lead to catastrophic outcomes. We report a case of a 24-year-old female newly diagnosed with SLE during COVID-19 pandemic who developed COVID-19 infection during her induction treatment for lupus nephritis. Case report - Case description A 24-year-old Nepali female, with no past medical history of note, presented to her regional hospital with a history of flu-like symptoms few days ago, peripheral oedema, acute kidney injury with proteinuria and hypertension. Further investigations showed a high titre of double-stranded DNA antibodies, anti-cardiolipin IgM and B2 microglobulin positive and low C3. She also developed a haemolytic anaemia and thrombocytopenia during her admission. She received pulsed steroid therapy and was started on mycophenolate mofetil (MMF) for a probable lupus nephritis awaiting the results of biopsy, which showed later a lupus nephritis Class IV-G with active lesions. She then developed symptoms of COVID-19 infection and had a positive PCR leading to an interruption of her induction therapy. She was recruited to the RECOVERY trial on the lopinavir-ritonavir arm and made a good recovery. Case report - Discussion It is well known that viruses can trigger or aggravate auto-immune response in patients predisposed genetically. However, the role of SARS-coV-2 is not elucidated yet. The EULAR COVID-19 registry showed that rheumatoid arthritis and SLE were the most prevalent rheumatic diseases, and there was an increased risk in those who are on moderate to high dose corticosteroids. In patients with SLE and COVID-19 infection, it is agreed by all the national and international rheumatology societies to interrupt their immunosuppressive therapy until the symptoms resolve, especially those with renal involvement or an active disease. Which is the case in our patient. Luckily, she resumed her MMF a month later after a negative PCR and her renal function has continued to improve. Case report - Key learning points Lupus nephritis is a major risk factor for overall morbidity and mortality in SLE. It requires an early immunosuppressive treatment to induce remission. Randomized clinical trials showed that MMF is at least equally effective as cyclophosphamide in inducing remission and that it has been associated with a reduced risk of infection and amenorrhea. It seems to be a suitable alternative in women of childbearing age. In patients with concomitant COVID-19 disease, immunosuppressive therapy should be paused until the symptoms improve.

scholarly journals Pregnancy Outcomes in Systemic Lupus Erythematosus Women

2021 ◽  
Vol 21 (2) ◽  
pp. e244-252
Author(s):  
Nihal Al-Riyami ◽  
Bushra Salman ◽  
Amani Al-Rashdi ◽  
Tamima Al-Dughaishi ◽  
Rahma Al-Haddabi ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Preterm Birth ◽  
Lupus Nephritis ◽  
Lupus Erythematosus ◽  
Pregnancy Outcomes ◽  
Adverse Pregnancy Outcomes ◽  
Intrauterine Fetal Death ◽  
Systemic Lupus ◽  
Adverse Pregnancy ◽  
The Impact

Objectives: This study was conducted to assess pregnancy outcomes in women with systemic lupus erythematosus (SLE) in Oman. Methods: A retrospective cohort study of 149 pregnancies in 98 women with SLE was conducted over 10 years to evaluate the impact of clinical and laboratory parameters in predicting adverse pregnancy outcomes. Results: Mean maternal age was 30.6 ± 5 years ranging from 20–44 years, and the mean disease duration was 10 ± 5 years, ranging from 2–27 years. The most common maternal manifestations were joint pain in 36 (24.2%), lupus nephritis (LN) in 18 (12.08%), preeclampsia in 11 (7.4%), eclampsia in three (2%) and lupus flare in one pregnancy. The live birth rate was 139 (93.3%) with a mean gestational age of 36 ± 2 weeks ranging from 26–40 weeks. In total, 55 (39.6%) were preterm deliveries, six (4%) pregnancies ended in miscarriage, and four (2.7%) resulted in intrauterine fetal death. Intrauterine growth restriction was observed in 49 babies (35%). A significant association was found between hypertension (HTN) and miscarriage (P = 0.024) and preterm birth (P = 0.019). In addition, HTN was positively associated with preeclampsia (P = 0.004) and LN (P = 0.048). Antiphospholipid syndrome impacted preterm birth (P = 0.013) and postpartem haemorrhage (PPH) (P = 0.027) and was found to be a significant predictor for women developing deep vein thrombosis and pulmonary embolism (P <0.001 for both). Conclusion: Despite potential complications, most pregnancies complicated by SLE in Oman result in good outcomes. Adverse pregnancy outcomes, however, may still occur in women with SLE. In women with SLE, pregnancy planning, careful antenatal monitoring and efficient SLE treatment need to be undertaken for successful pregnancy outcomes. Keywords: Systemic Lupus Erythematosus; Pregnancy Outcomes; Lupus Nephritis; Antiphospholipid Antibodies; Neonatal Lupus.

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